Department of Pharmacy, Birla Institute of Technology and Sciences Pilani, Hyderabad, Telangana, India.
Centre for Molecular Biology, Central University of Jammu, Jammu, UT of Jammu and Kashmir, India.
Hypertens Res. 2021 Jul;44(7):740-755. doi: 10.1038/s41440-021-00643-z. Epub 2021 Mar 17.
The renin-angiotensin-aldosterone system (RAAS) is responsible for maintaining blood pressure and vascular tone. Modulation of the RAAS, therefore, interferes with essential cellular processes and leads to high blood pressure, oxidative stress, inflammation, fibrosis, and hypertrophy. Consequently, these conditions cause fatal cardiovascular and renal complications. Thus, the primary purpose of hypertension treatment is to diminish or inhibit overactivated RAAS. Currently available RAAS inhibitors have proven effective in reducing blood pressure; however, beyond hypertension, they have failed to treat end-target organ injury. In addition, RAAS inhibitors have some intolerable adverse effects, such as hyperkalemia and hypotension. These gaps in the available treatment for hypertension require further investigation of the development of safe and effective therapies. Current research is focused on the combination of existing and novel treatments that neutralize the angiotensin II type I (AT1) receptor-mediated action of the angiotensin II peptide. Preclinical studies of peptide- and nonpeptide-based therapeutic agents demonstrate their conspicuous impact on the treatment of cardiovascular diseases in animal models. In this review, we will discuss novel therapeutic agents being developed as RAAS inhibitors that show prominent effects in both preclinical and clinical studies. In addition, we will also highlight the need for improvement in the efficacy of existing drugs in the absence of new prominent antihypertensive drugs.
肾素-血管紧张素-醛固酮系统(RAAS)负责维持血压和血管张力。因此,RAAS 的调节会干扰基本的细胞过程,导致高血压、氧化应激、炎症、纤维化和肥大。这些情况会导致致命的心血管和肾脏并发症。因此,高血压治疗的主要目的是降低或抑制过度激活的 RAAS。目前可用的 RAAS 抑制剂已被证明可有效降低血压;然而,除了高血压之外,它们未能治疗终末靶器官损伤。此外,RAAS 抑制剂有一些不可耐受的不良反应,如高钾血症和低血压。这些高血压治疗的空白需要进一步研究安全有效的治疗方法。目前的研究集中在现有的和新的治疗方法的组合上,这些方法可以中和血管紧张素 II 肽的血管紧张素 II 型 1(AT1)受体介导的作用。基于肽和非肽的治疗剂的临床前研究表明,它们在动物模型中的心血管疾病治疗中具有显著的作用。在这篇综述中,我们将讨论作为 RAAS 抑制剂开发的新型治疗剂,这些治疗剂在临床前和临床研究中都显示出了显著的效果。此外,我们还将强调在没有新的突出降压药物的情况下,需要提高现有药物的疗效。